RESUMEN
Routinely performed, CT is useful and reliable for staging lower limb lymphedema. We describe methods we utilized. We found in frequency order: skin thickening, subcutaneous tissues area increase in regard the safe limb, perimuscular aponevrosis thickening, fat infiltration: lines parallel to the skin, edematous areas along perimuscular aponevrosis, lines perpendicular to the skin. The lowest fat density is increased on the pathologic side. Subfascial compartment is slightly fattened. We found huge differences between primary and secondary lymphedema for the thigh. Same images may be generated by old or young lymphedema. Rarely useful for positive diagnosis, CT is indispensable for secondary lymphedema staging (initial staging or after a recent increase). It seems us indispensable for any pretherapeutic staging (whole objectively disorders, exact upper limit, infraclinic bilaterality).
Asunto(s)
Linfedema/clasificación , Linfedema/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Femenino , Humanos , Pierna/patología , Linfedema/patología , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
The aim of this study was to identify the nature of the nerve lesions found in patients with neurological complains and with lymphedema occurring after breast cancer treated by surgery and radiotherapy. Twelve patients treated in a specialised centre for lymphology had clinical and neurophysiological examinations. This study found 9 radiation-induced plexopathies, 1 neoplasic plexopathy, 2 carpal tunnel syndromes (one isolated), 1 cervical root disease and 1 normal examination. The radiation-induced plexopathy is characterised by a chronic neurogenic involvement and the presence of (motor and sensory) proximal persistent conduction blocks. This study demonstrated that it is essential to identify with electrodiagnosis the exact nature of the nerve lesion to determine the most appropriate and effective treatment.
Asunto(s)
Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/fisiopatología , Linfedema/complicaciones , Examen Neurológico , Enfermedades del Sistema Nervioso Periférico/etiología , Brazo , Electrodiagnóstico/métodos , Potenciales Evocados , Femenino , Humanos , Linfedema/fisiopatología , Persona de Mediana Edad , Neurofisiología , Enfermedades del Sistema Nervioso Periférico/diagnósticoRESUMEN
The aim of this work was to evaluate the usefulness of CT imaging to stage lower limb lymphedemas. Between 1992 and 1997, we studied 150 cases of lymphedema, half idiopathic and half secondary. Methods used are described. In decreasing order of frequency, we found: skin thickening, increased subcutaneous tissue surface area compared with the healthy limb, thickening of the perimuscular aponevrosis, fat infiltration: lines parallel to the skin (parallel), edematous areas along the perimuscular aponevrosis, lines perpendicular to the skin (perpendicular). The lowest fat density was increased on the diseased side. The subfascial tissue showed some fat accumulation. These results were compared with findings reported in the literature. There were very major differences between idiopathic lymphedema and secondary lymphedema of the thigh. Similar images were generally generated by new and long-standing lymphedema. Rarely useful for positive diagnosis, CT is indispensable for establishing stage initially or after recent increase and, in our opinion, is essential for pretherapeutic assessment. The CT-scan gives objective evidence of overall disorders, the exact upper limit of the lymphedema, and sometimes reveals infraclinical bilateral involvement.
Asunto(s)
Pierna/diagnóstico por imagen , Linfedema/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Linfedema/clasificación , Linfedema/etiología , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
We examined retrospectively 11 patients with isolated unilateral lower limb lymphedema (clinical criteria confirmed by isotope lymphography) using computer tomography. In conjunction with earlier observations, the findings of soft tissue stranding, skin thickening, fat deposition in the epifascial compartment and perimuscular fascial thickening and edema relate to lymph stasis. This noninvasive and relatively simple imaging technique allows analysis of soft tissue changes in leg lymphedema and can be used to evaluate lymphatic insufficiency and its extent as well as document the response to treatment.
Asunto(s)
Pierna/diagnóstico por imagen , Linfedema/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Fifty seven patients with secondary lymphedema of the upper limb after previous treatment for breast cancer were treated for 3 months with an extract of Ruscus + Hesperidin Methyl Chalcone (CYCLO 3 FORT) or placebo according to a double-blind protocol in the context of a controlled clinical trial. All patients also underwent manual lymphatic drainage twice a week for at least one month. With CYCLO 3 FORT, the reduction in volume of arm edema, the main assessment criteria, was 12.9% after 3 months of treatment as compared with a placebo (p=0.009). Decreased edema tended to be more marked in the forearm compared with the upper arm where excess fat deposition seemed to dominate over excess fluid accumulation. CYCLO 3 FORT was well tolerated with minimal adverse reaction.